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Karen Eggleston
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Clear evidence suggests the importance of health service provider payment incentives for achieving efficiency, equal access, and quality, including attention to primary, secondary, and tertiary prevention. “Pay for performance” may be on the cusp of significant expansion in Asia, and reform away from fee-for-service has been underway for several years in several economies. Yet despite the policy relevance, the evidence base for evaluating payment reforms in Asia is still very limited.

China in particular has been undertaking significant reforms to its health care system in both rural and urban areas. With the expansion of insurance coverage and need to resolve incentive problems like “supporting medical care through drug sales,” there is an urgent need for evaluating alternative ways of paying health service providers. Evidence from policy reforms in specific regions of China, as well as other economies of the Asia-Pacific, can provide valuable evidence to help inform policy decisions about how to align provider incentives with policy goals of quality care at reasonable cost.

To illuminate these questions, the Asia Health Policy Program and several collaborating institutions are planning to convene a conference on health care provider payment incentives on November 7-8, 2008 in Beijing. The conference will highlight and seek to distill “best-practice” lessons from rigorous and policy-relevant evaluations of recent reforms in China and elsewhere in the Asia Pacific.

The organizing committee – including health economists from Shorenstein APARC, Peking University, Tsinghua University, and Seoul National University – reviewed submissions in June 2008 and accepted sixteen. The conference papers cover payment issues in Korea, Japan, China, Taiwan, Thailand, Tajikistan, the Philippines, and the US, and the disciplines of economics, health services research/health policy, public health, medicine, and ethics. Topics include institutionalized informal payments; the impact of global budget policies on high-cost patients; public-private partnerships; public-sector physicians owning private pharmacies; evidence-informed case payment rates; payment and hospital quality; bonuses and physician satisfaction; physician prescription choice between brand-name and generic drugs; and differences in pharmaceutical utilization across insurance plans that pay providers differently (fee-for-service versus capitation).

Policymakers from China’s National Development and Reform Commission and Ministry of Health will also speak at the conference. Selected research papers will be published through the Shorenstein Asia-Pacific Research Center either in a special volume or in a special issue of an English-language health policy journal.

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It was meant to be a celebration not a showdown, let alone a showdown that the brutal junta in Burma (Myanmar) would win. In August 2007, the Association of Southeast Asian Nations (ASEAN) turned forty. On November 20, to mark the occasion, the heads of government of the association's ten member states-Brunei, Burma, Cambodia, Indonesia, Laos, Malaysia, the Philippines, Singapore, Thailand, and Vietnam-met in Singapore for the thirteenth ASEAN Summit. A day later the heads of government from Australia, China, India, Japan, New Zealand, and South Korea joined them for the third East Asia Summit (EAS).

The summitry had three purposes. The first was to commemorate ASEAN's first forty years. From only five members at its inception in 1967, the association had by 1999 grown to encompass all of Southeast Asia's formerly quarrelsome states. For the first time in the region's history, a single indigenous organization could claim to stand for all of Southeast Asia-albeit only by overlooking just how variously accountable ASEAN's diverse regimes were to the peoples whom they presumed to represent.

But ASEAN was not content to rest on these laurels. The second reason for the summitry in Singapore was to prepare the organization for the future. The ASEAN summit's peak event was to be the unveilingand signing of a first-ever charter for the organization.

Finally, the packed schedule in Singapore was meant to project the best possible image of ASEAN to the assembled foreign guests and the wider world. By inaugurating a charter meant to enhance the association’s effectiveness, the organizers of the celebrations hoped to belie Western criticism that ASEAN was little more than a “talking shop.” They also hoped that showcasing the charter would distract attention from the presence in Singapore of ASEAN’s most widely castigated member, Burma, and thereby gain some relief from Western charges of guilt by association with that pariah state.

It was not to be. The summit was convened and the charter was signed. Plans to implement the ASEAN Economic Community were announced. But the Burmese junta stole the spotlight from these accomplishments in a way that tainted the anniversary, embarrassed the association in front of its foreign guests, and reminded analysts just how tenuously regionalism is related to democracy in Southeast Asia.

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Donald K. Emmerson
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Major economic reforms are often politically difficult, causing pain to voters and provoking unrest. They may be opposed by politicians with short time horizons. They may collide with the established ideology and an entrenched ruling party. They may be resisted by bureaucrats and by vested interests. Obstacles to major economic reform can be daunting in democratic and autocratic polities alike.

And yet, somehow, past leaders of today's Asian dragons did implement vital economic reforms. The paper recounts the political maneuvers used by leaders of economic reform in Asia during these pivotal eras: China under Deng Xiaoping; India in the 1990s; Thailand under General Prem Tinsulanonda; Vietnam's Doi Moi; South Korea under Park Chung Hee; and Singapore under Lee Kuan Yew.

The last part of the paper classifies these maneuvers as responses to the main political barriers to reform. It serves as a "playbook" of tactics for economic reformers. For example, to overcome ideological baggage, the reformers packaged reforms as means to strengthen the party in power. They reformed gradually, initially seeking win-win compromises. They blessed pro-market violations as pilot projects. They even created new provinces to dilute the anti-reform vote.

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Dennis Arroyo
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Major economic reforms are often politically difficult.  They may cause pain to voters and provoke unrest.  They may be opposed by politicians whose time horizons are shortened by electoral cycles.  They may collide with the established ideology and long-standing practices of an entrenched ruling party.  They may be resisted by bureaucrats who fear change, and by vested interests with stakes in the status quo.  Obstacles to major economic reform can be daunting in democratic and autocratic polities alike. 

And yet, somehow, past leaders of today's Asian dragons did manage to get away with critical and creative economic reforms.  Sly political foxes nudged their countries onto high-growth paths toward global renown as economic dragons.  What lessons can be learned from their experiences?  Are tactics that worked in authoritarian systems applicable to democratic ones, and vice versa?  Can one identify a set of stratagems that would amount to an equivalent, for economic reformers, of the advice Machiavelli gave political princes? 

Arroyo will recount the crafty political maneuvers used by leaders of economic reform in Asia during these pivotal eras:  China under Deng Xiaoping; India in the 1990s; Thailand under General Prem Tinsulanonda; Vietnam's Doi Moi; South Korea under Park Chung Hee; Malaysia under Mahathir Mohamad; and Singapore under Lee Kuan Yew.  Arroyo's remarks will be drawn from the paper he has been writing at Stanford on "The Political Economy of Successful Reform: Asian Stratagems," which he describes as "a playbook of useful maneuvers for economic reformers."

Dennis Arroyo is presently on leave from his government post as a director of the National Economic and Development Authority (NEDA) of the Philippines.  He has held consultancies with the World Bank, the United Nations, and the survey research firm Social Weather Stations, and has written widely on socioeconomic topics.  His critique of the Philippine development plan won a mass media award for "best analysis."  He has degrees in economics from the University of the Philippines.  

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Dennis Arroyo is a corporate affiliate visiting fellow at Shorenstein APARC for 2007-08. Prior to joining Shorenstein APARC, he worked as the Director of National Planning and Policy Staff at the National Economic and Development Authority in the Philippines. Arroyo also formerly worked as a consultant for the World Bank in Washington DC and the World Bank office in Manila. Arroyo has spent much of his career in survey research with Social Weather Stations (SWS), which is a prominent organization in the World Association for Public Opinion Research (WAPOR).

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Dennis Arroyo 2007-2008 Shorenstein APARC/Asia Foundation Visiting Fellow Speaker Shorenstein APARC
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This program will bring together some of the world's leading experts on Southeast Asia and democracy to consider critical questions facing the region. Has the American model of democracy become tarnished in Asia, and is the Chinese model of authoritarian capitalism of growing appeal and significance? What are the dimensions and implications of Islamicization for Southeast Asia? What are the prospects for cleaning up notoriously corrupt party politics? Will the military ever be driven out of politics in places like Thailand and the Philippines? Is the American-led "war on terror" helping stabilize politics in the region, or is it exacerbating already serious problems? What do these developments mean for U.S. foreign policy and American influence in Asia?

 

Kishore Mahbubani, one of Asia's leading public intellectuals, is author of the forthcoming The New Asian Hemisphere: the Irresistible Shift of Global Power to the East; and Can Asians Think? and Beyond the Age of Innocence: Rebuilding Trust Between America and the World. Now the dean and professor of the Lee Kuan Yew School of Public Policy at the National University of Singapore, he served for 33 years as a diplomat for Singapore.

Larry Diamond is a senior fellow at the Hoover Institution, Stanford University, and the author or editor of more than twenty books, including Squandered Victory: The American Occupation and the Bungled Effort to Bring Democracy to Iraq, and the newly-released The Spirit of Democracy: The Struggle to Build Free Societies Throughout the World.

Donald K. Emmerson has written or edited more than a dozen books and monographs on Southeast Asian politics, including the forthcoming Hard Choices: Security, Democracy, and Regionalism in Southeast Asia and Indonesia Beyond Suharto. His latest publication is titled "Challenging ASEAN" (Jan 2008). He is a senior fellow at the Freeman Spogli Institute for International Studies at Stanford University, where he also heads the Southeast Asia Forum.

Douglas Bereuter (moderator) is president of The Asia Foundation. He assumed his current position after 26 years of service in the U.S. Congress, where he was one of that body's leading authorities on Asian affairs and international relations.

Co-sponsored with the Asia Society; Business Executives for National Security; UC Berkeley Center for Southeast Asian Studies; USF Center for the Pacific Rim; and the World Affairs Council of Northern California.

Click here to listen to the audio recording of this panel discussion.

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At Stanford, in addition to his work for the Southeast Asia Program and his affiliations with CDDRL and the Abbasi Program in Islamic Studies, Donald Emmerson has taught courses on Southeast Asia in East Asian Studies, International Policy Studies, and Political Science. He is active as an analyst of current policy issues involving Asia. In 2010 the National Bureau of Asian Research and the Woodrow Wilson International Center for Scholars awarded him a two-year Research Associateship given to “top scholars from across the United States” who “have successfully bridged the gap between the academy and policy.”

Emmerson’s research interests include Southeast Asia-China-US relations, the South China Sea, and the future of ASEAN. His publications, authored or edited, span more than a dozen books and monographs and some 200 articles, chapters, and shorter pieces.  Recent writings include The Deer and the Dragon: Southeast Asia and China in the 21st Century (ed., 2020); “‘No Sole Control’ in the South China Sea,” in Asia Policy  (2019); ASEAN @ 50, Southeast Asia @ Risk: What Should Be Done? (ed., 2018); “Singapore and Goliath?,” in Journal of Democracy (2018); “Mapping ASEAN’s Futures,” in Contemporary Southeast Asia (2017); and “ASEAN Between China and America: Is It Time to Try Horsing the Cow?,” in Trans-Regional and –National Studies of Southeast Asia (2017).

Earlier work includes “Sunnylands or Rancho Mirage? ASEAN and the South China Sea,” in YaleGlobal (2016); “The Spectrum of Comparisons: A Discussion,” in Pacific Affairs (2014); “Facts, Minds, and Formats: Scholarship and Political Change in Indonesia” in Indonesian Studies: The State of the Field (2013); “Is Indonesia Rising? It Depends” in Indonesia Rising (2012); “Southeast Asia: Minding the Gap between Democracy and Governance,” in Journal of Democracy (April 2012); “The Problem and Promise of Focality in World Affairs,” in Strategic Review (August 2011); An American Place at an Asian Table? Regionalism and Its Reasons (2011); Asian Regionalism and US Policy: The Case for Creative Adaptation (2010); “The Useful Diversity of ‘Islamism’” and “Islamism: Pros, Cons, and Contexts” in Islamism: Conflicting Perspectives on Political Islam (2009); “Crisis and Consensus: America and ASEAN in a New Global Context” in Refreshing U.S.-Thai Relations (2009); and Hard Choices: Security, Democracy, and Regionalism in Southeast Asia (edited, 2008).

Prior to moving to Stanford in 1999, Emmerson was a professor of political science at the University of Wisconsin-Madison, where he won a campus-wide teaching award. That same year he helped monitor voting in Indonesia and East Timor for the National Democratic Institute and the Carter Center. In the course of his career, he has taken part in numerous policy-related working groups focused on topics related to Southeast Asia; has testified before House and Senate committees on Asian affairs; and been a regular at gatherings such as the Asia Pacific Roundtable (Kuala Lumpur), the Bali Democracy Forum (Nusa Dua), and the Shangri-La Dialogue (Singapore). Places where he has held various visiting fellowships, including the Institute for Advanced Study and the Woodrow Wilson International Center for Scholars. 



Emmerson has a Ph.D. in political science from Yale and a BA in international affairs from Princeton. He is fluent in Indonesian, was fluent in French, and has lectured and written in both languages. He has lesser competence in Dutch, Javanese, and Russian. A former slam poet in English, he enjoys the spoken word and reads occasionally under a nom de plume with the Not Yet Dead Poets Society in Redwood City, CA. He and his wife Carolyn met in high school in Lebanon. They have two children. He was born in Tokyo, the son of U.S. Foreign Service Officer John K. Emmerson, who wrote the Japanese Thread among other books.

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A long-time loose group of countries focused on trade and business, the Association of Southeast Asian Nations is trying to forge a common market roughly similar to the European Union. But the question of how to confront Myanmar's crackdown on democracy has left ASEAN divided. Will Indonesia, Malaysia, Thailand and Singapore start to take a stand on democracy, and are they turning away from the US as China booms? Dr. Donald K. Emmerson is director of the Southeast Asia Forum at Stanford's Shorenstein Asia-Pacific Research Center and the author of many papers and books on the region comments on the adoption of the charter on KCRW's To the Point. Link to audio file of the entire day's show below. Professor Emmerson's interview begins at about 42 minutes into the show.
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We are pleased to announce the first article of the new academic year in our series of Shorenstein APARC Dispatches. This month's piece comes from Dr. John D. Ciorciari, one of this year's Shorenstein Fellows. Dr. Ciorciari's current research centers on the alignment policies of small states and middle powers in the Asia-Pacific region. He also has interests in international human rights law and international finance. In this piece, Dr. Ciorciari shares some comments on "Myanmar After the Saffron Revolution."

In late September, tens of thousands of Buddhist monks took to the streets of Myanmar, leading the largest uprising against the ruling State Peace and Development Council (SPDC) since 1988. A sharp and sudden hike in fuel prices sparked the protests, but to the regime's many critics, the revolt displayed the depth of popular discontent with economic mismanagement, corruption, and political repression in Myanmar. Images of unarmed monks confronting the feared tatmadaw (armed forces) won the protesters considerable moral support from abroad, as did a public appearance by Aung San Suu Kyi. Some observers anticipated that the "saffron revolution" would lead to the overthrow of the regime, as occurred during the "rose," "orange," and "tulip" revolutions in Georgia, Ukraine, and Kyrgyzstan.

The tatmadaw responded swiftly and brutally, however. Troops imposed tight curfews, raided pagodas, and used clubs and tear gas to disperse protesters. In a matter of days, the armed forces killed numerous demonstrators, arrested or detained thousands more, and re-imposed control. The saffron revolution thus appears to have subsided, and the outlook is not promising for advocates of regime change or dramatic policy shifts in Myanmar.

The episode did reveal some minor cracks in the SPDC edifice. Colonel Hla Win, a longtime senior member of the junta, reportedly defected into an ethnic Karen rebel-controlled area and is seeking political asylum after defying an order to massacre a group of monks. At least one senior army official has leaked incriminating evidence to the press, and a foreign ministry official resigned at the government's "appalling" response to the protests. Prime Minister Soe Win has been hospitalized with leukemia for months. Rumors even swirled of a coup. Nevertheless, SPDC chairman Than Shwe, his deputy Maung Aye, and other cabinet members appear to have closed ranks, and the SPDC looks quite firmly entrenched.

International responses to the uprising and military response have been mixed. Western governments and activist groups quickly condemned the SPDC and pushed the regime to open dialogue with Aung San Suu Kyi's opposition National League for Democracy. U.S. President George W. Bush announced tighter sanctions shortly after the crackdown began. Japan--which has favored engagement in the past--is now considering sanctions and has demanded an explanation and an apology for the shooting of a Japanese journalist.

To dampen international pressure, the SPDC allowed Nigerian diplomat Ibrahim Gambari to enter the country as a UN special envoy. Gambari has met with both Than Shwe and Aung San Suu Kyi to convey the UN's concerns about the crackdown. The SPDC has also appointed retired general U Aung Kyi as an official interlocutor with Aung San Suu Kyi and has made gestures of conciliation to the clergy. However, the Myanmar leadership has rebuffed demands for more serious political dialogue or far-reaching policy reforms.

A degree of Chinese and Russian protection has helped shield the SPDC from international pressure. China and Russia vetoed a U.S.-sponsored UN Security Council resolution demanding that the SPDC free all political prisoners. Officials in Beijing and Moscow argued that the unrest was an "internal matter" unsuited for Security Council action. Their defense of a strong norm of sovereignty--rooted largely in their fear of similar Western attacks--provides political cover for the SPDC. Their objection to isolating Myanmar economically also makes it unlikely that a program of enhanced U.S. and European sanctions will bring the junta to its knees. As long as Myanmar's neighbors do business with the SPDC, it will probably survive.

To date, divergent foreign policy priorities have conspired against a genuinely multilateral policy to drive reform in Myanmar. For China, Myanmar is a strategic gateway to the East Indian Ocean and a source of prized raw materials, as well as a political ally on issues of state sovereignty. India and Thailand have also been loath to cut off or alienate their troublesome neighbor. India has little ideological affection for the SPDC but rejects sanctions and has responded quietly to recent events in Myanmar. Indian officials view Myanmar as an important regional pivot with China and a source of natural resources. Thai policymakers, worried about refugees and instability in ethnic minority enclaves along the border, have tended to prioritize stability over reform in relations with the SPDC. Both India and Thailand derive considerable economic benefits--both legal and illicit--from an open border. In addition, they fear that using their limited leverage to attack the junta will drive it further into China's embrace.

The governments of other member states of the Association of Southeast Asian Nations (ASEAN) have split on the issue. Indochinese states defend Myanmar's sovereignty, while the Philippines, Singapore, Malaysia, and Indonesia have been more openly critical. With a bit of diplomatic legerdemain, Singapore expressed ASEAN's grave concern to Myanmar, speaking as the Association's chair. Discourse in regional think tanks suggests that a growing number of Southeast Asian officials advocate Myanmar's suspension from ASEAN. Although suspension would push Myanmar even further into the margins of international society, it would be unlikely to unseat the SPDC. Isolation also bears obvious risks; cloning North Korea is not in any ASEAN government's interest.

Most analysts agree that China holds the key to improving the prospects for reform, development, and democracy in Myanmar. Indeed, a change in Chinese policy would increase the likelihood of tougher Indian and ASEAN stances, since a fear of encouraging close Sino-Myanmar ties helps justify their existing approaches. The possibility of embarrassment at the upcoming Olympic games provides a short-term incentive for China to press the SPDC for better governance. A longer-term incentive will be to secure the countries' shared border, which is plagued by narco-trafficking, illegal migration, and ethnic conflict. Finally, China has an incentive to build its credibility as a constructive force in Southeast Asia and beyond. Chinese officials have led a well-documented "charm offensive" in the region, both bilaterally and through multilateral institutions, to build influence. To the extent that ASEAN governments make reform in Myanmar a priority, China can show itself to be a responsible stakeholder in Southeast Asia's future.

In the near term, a coalescence of the policies of regional powers is unlikely. Moreover, strong regional pressure does not guarantee seismic policy shifts in Myanmar. The SPDC's harsh response to the protests--like its 2006 decision to move the national capital to a remote area--testifies to considerable paranoia. Still, the outside world has economic, security, and moral reasons to hold Myanmar to higher standards of governance. The pace and direction of change will depend only marginally on the severity of Western sanctions, which bite but do not cripple the regime. Western governments' ability to identify common objectives and forge cooperation with Asian partners will be more determinative. Ultimately, the development of concerted action by relevant Asian states is likely to be the rate-limiting step in the equation. The saffron revolution suggests that many domestic actors are prepared to assume risks to promote reform if Myanmar's neighbors take a tougher stand and help provide the enabling conditions for change.

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Shorenstein APARC Dispatches are regular bulletins designed exclusively for our friends and supporters. Written by center faculty and scholars, Shorenstein APARC Dispatches deliver timely, succinct analysis on current events and trends in Asia, often discussing their potential implications for business.

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Tectonic shifts have underscored the gradual Islamization of mainstream politics in contemporary Malaysia. This is so despite popular media representations of the country as an epitome of moderate and progressive Muslim governance -- a portrayal regularly belied by the actions of its leaders as well. Recently, these shifts have been expressed in heated debates over apostasy, religious freedom, and constitutional rights. Insofar as the media have acknowledged Islamization, they have attributed it to the Islamist opposition party (PAS). Prof. Liow will show, however, that the ruling party (UMNO) has proven no less strident in expressing its own Islamist predilections, with significant implications for the dynamics of UMNO-PAS relations and, beyond them, the country's political future.

Joseph Chinyong Liow is head of research at S. Rajaratnam School of International

Studies, Nanyang Technological University, Singapore. His books include Muslim

Resistance in Southern Thailand and Southern Philippines: Religion, Ideology, and Politics (2006); The Politics of Indonesia-Malaysia Relations: One Kin, Two Nations (2005); and (as co-editor) Order and Security in Southeast Asia (Routledge 2006). He is associate editor of Asian Security, and guest-edited "Internal Conflicts in Southeast Asia: The Nature, Legitimacy and Changing Role of the State," a special issue of that journal (2007). He has published numerous articles on Malaysian politics and the conflict in Southern Thailand. His PhD is from the London School of Economics and Political Science.

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Joseph Chinyong Liow Associate Professor Speaker S. Rajaratnam School of International Studies, Nanyang Technological University, Singapore
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Nae-Young Lee is a Professor of the Department of Political Science and Director of Asiatic Research Center at Korea University. He also serves as Director of Center for Public Opinion Research at the East Asia Institute, and an Executive Board Member of the Korean Political Science Association. Professor Lee received his Ph. D. from the University of Wisconsin-Madison and was a professor at Kyung Hee University, a research fellow at the Sejong Institute, and a member of the Presidential Policy Planning Committee.

As an expert on Korean and Comparative Politics, Electoral Studies, East Asian Political Economy, he has coauthored and edited various books and published numerous articles in international and Korean scholarly journals. His recent works include 5.31 Local Elections and Changing Korean Voters (2007), Is Rising China Threat or Opportunity?: Analysis of Cross-National Opinion Survey (2007), Changing ROK-US Alliance and Public Opinion (2005), Democratization and Historical Rectification in East Asia: Comparison of South Korea, the Philippines, and Thailand (2004), 2002 Presidential Election and Tasks of Roh Moo-hyun Government (2003), Dilemma and Choice of Roh Moo-hyun Government (2003), "Issues and Partisan Realignment in South Korea" (2007), "Changes in Korean Public Perception of the U.S. and Korea-U.S. Relations" (2005) and "Fluctuating Anti-Americanism and the Korea-U.S. Alliance" (2004).

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